Three Models of Osteopathy Revisited
In this article I’ll talk about the Functional model. I’ve already discussed the biomechancial model and the next article will talk about my favorite, the Biodynamic Model. The truth is, most osteopathic physicians use some of all three.
I’ll be introducing some technical terms, like direct/indirect, thoracic respiration, neutral,… but the take away point is that the functional model is not as directive or as linear as the biomechanical model. In fact, the diagnosis and treatment occur simultaneously.
To understand differences in these models, it’s helpful to understand a little bit about therapeutic forces.
In the biomechanical model, the osteopathic doctor, based on a knowledge of normal anatomy, diagnoses abnormal structural findings, and applies a force to return those abnormal structures to normal. The therapeutic force is can be gentle and precise – such as a thrust. Or it can involve rubbing or stretching of tissues. The amount of pressure applied in any type of biomechanical technique is dependent on the technique and the style of the doctor.
There are many different types of therapeutic forces. For example, a fever is a therapeutic force. The body generates heat which changes the internal environment and can kill of bacterial infections. Therapeutic forces come from inside and outside of the body. They are generated by the natural world, including our physiology, and they can be generated by a doctor using their hands or tools, such as needles and percussion hammers.
The functional model relies on breathing, or thoracic respiration, as the primary therapeutic force. Osteopathic doctors haven’t cornered the market on this powerful tool. Thoracic respiration is used in many modalities – think about calming yourself down by taking deep breaths, or meditations that focus on breath-work for example.
But a look at the anatomy of the major fulcrum of this breathing reveals it is deeply connected to all body systems. For example, the lymphatics, one part of the body that carries away illness and help balance fluids are abundant on the under surface of the primary muscle used in breathing – the diaphragm. Two of the largest vessels in the body – the aorta and vena cava run through the diaphragm as well as part of the digestive system, the esophagus. That means that changes in breathing impact our blood supply, our heart rate, our digestion…. again, it’s a powerful force in the body.
How is respiration used in the functional model? First let’s talk about two types of technique: direct and indirect.
Direction of Ease
The term direction of ease is important in understanding osteopathic techniques. Normal movement is mostly symmetric -for example, you should be able to turn your head right and left equally. But most of us have poor postural habits and spend too much time in front of screens or at desks and you are likely to discover that you move your head more easily one direction. That’s your direction of ease. Techniques that use this direction of ease as the starting position are called indirect.
Biomechanical techniques can be done using the direction of ease – indirect – or they can be direct techniques. The Functional model – often called Functional Technique almost always uses the direction of ease. The Osteopath uses one hand to listen to the tissues and the other to direct movement of them. Getting back to Thoracic Respiration – it is both diagnostic and therapeutic in the functional model, and as the treatment happens the breathing settles down and becomes more integrated throughout the whole body. The doctor is directing the treatment, watching the breathing to monitor its efficacy, and as the breathing settles and integrates it causes the body to transport blood, waste and nutrients – essentially to heal.
The end point of a treatment is a neutral state or state of calm rest that pervades the whole system. From this state of neutral, or homogenization, the body can access all internal healing therapeutics.
The essential premise in this model is that motion, introduced by the doctor in a precise but indirect will result in a return to normal function of the body part being treated using breathing to both augment the force applied by the doctor and to determine when the treatment is done. The force applied when using the Functional model is minimal but powerful.